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S8- Diagnostic Imaging > W1- Fracture Evaluation > Flashcards

W1- Fracture Evaluation Flashcards

1
Q

What is the most common MOI for presentations requiring radiology services?

A

Trauma

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2
Q

Which modalities are commonly used for trauma assessment? (3)

A
  1. ) Radiograph
  2. ) CT (complex anatomy)
  3. ) MRI (soft tissue injury and subtle fractures)
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3
Q

What are the goals of radiology? (3)

A
  1. ) Dx and Evaluate characteristics
  2. ) Compare w/ clinical Hx/reported MOI
  3. ) Assess/monitor for response to Tx, healing, and complications
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4
Q

What is the difference between primary and secondary trauma survey?

A
  • Primary = Imaging initially administered in ED to help screen and prioritize injuries.
  • Secondary = F/u imaging necessary once pt is clinically stable.
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5
Q

What are the set of procedures commonly done when a pt comes in with high-velocity injury? (3) (vs directly to CT)

A
  1. ) Cross-table lateral of the c-spine
  2. ) AP Chest
  3. ) AP Pelvis
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6
Q

What are some additional procedures that may be done with a pt presenting with a high-velocity injury? (6)

A
  • Focused Abdominal Ultrasound for Trauma (FAST)
  • CT of head
  • CT of C-spine
  • CT of thorax, abdomen, pelvis
  • Lateral T/L spine radiograph
  • Extremity radiographs
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7
Q

List possible complications from the following injuries:

  • Pelvic/Femur Fx
  • Multiple/crushing type Fx
  • Elbow Fx
  • Proximal humeral Fx
  • Shoulder dislocation
  • Elbow dislocation
  • Hip dislocation
  • Knee dislocation
A
  • Pelvic/Femur Fx = Hemorrhage
  • Multiple/crushing type Fx = Fat embolism
  • Elbow Fx = Brachial artery injury
  • Proximal humeral Fx = Axillary nerve injury
  • Shoulder dislocation = Axillary artery/nerve injury, Brachial plexus
  • Elbow dislocation = Brachial artery injury, Median/Ulnar nerve injury
  • Hip dislocation = Femoral artery/nerve injury
  • Knee dislocation = Popliteal artery injury, peroneal nerve injury
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8
Q

With trauma, __-_____ is critical.

A

c-spine

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9
Q

Extremity Fx:

  • > /= __ views that are ____ degrees from each other.
  • ____ and ______ views when possible.
  • Include _______ joints.
A
  • > /=2 views, 90 degrees
  • AP and lateral
  • adjacent
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10
Q

What are the 2 types of bone?

A
  • Cancellous = spongy

- Cortical = dense

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11
Q

What are some ways to describe fractures? (8)

A
  1. ) Open vs Closed
  2. ) Anatomical site and extent
  3. ) Type (complete vs incomplete)
  4. ) Alignment of fragments
  5. ) Direction of fracture lines
  6. ) Special features
  7. ) Associated abnormalities
  8. ) Special types
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12
Q

What is the difference between a open and closed fracture?

A
  • Open Fx = breaks skin barrier

- Closed Fx = doesn’t break skin barrier

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13
Q
  • Long bones are divided into ______.

- Ends are further divided into ______ and _________

A
  • thirds (proximal, middle, distal)

- intra and extraarticular

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14
Q

What is the difference between a complete and incomplete fracture?

A
  • Complete = All cortices disrupted.

- Incomplete = Bone not broken into 2 pieces and is mostly in short bones and children.

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15
Q

> 2 fragments = _______ Fx

A

Comminuted Fx

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16
Q

What is important to note in regards to the alignment of fractures?

A

Displaced vs Non-displaced

  • Direction of displacement
  • Amount of displacement
  • Distraction, overriding, rotation

Alignment vs Angulation
-Longitudinal relationship of fragments

17
Q
  • Direction of fracture lines are in reference to the ________ axis.
  • What are (4) directions of fracture lines?
A
  • longitudinal

- transverse, longitudinal, oblique, spiral

18
Q
  • What is a impaction Fx?

- What is an avulsion Fx?

A

Impaction Fx
-Compression with axial load.

Avulsion
-Tensile loading of fragment and main body of bone. (muscle contraction or passive loading)

19
Q

Pediatric Fx:

  • Greenstick = Fx on side of _______ loading.
  • Torus = Fx on side of _____ loading.
  • What is plastic bowing?
A
  • Greenstick = Fx on tensile side
  • Torus = Fx on compressive side
  • Plastic Bowing = Longitudinal compression forces exerted, capacity for elastic recoil exceeded.
20
Q

Describe the first 5 types of Pediatric Physeal Fractures.

A 
Type I (S)
-Growth plate only.
Type II (A)
-Physis and metaphysis.
Type III (L)
-Physis and epiphysis.
Type IV (T)
-Epiphysis, physis, and metaphysis.
Type V (R)
-Crush injury of physis.

Slipped, Above, Lower, Through, Ruined

21
Q

Type VI (Rang’s) Pediatric Physeal Fracture involves the ___________ or associated periosteum of physis.

A

-perichondrial ring

22
Q

Type VII-IX (Ogden’s) do not directly involve physis, though may disrupt _____ _______.

A

-blood supply

23
Q
  • Type VII = osteochondral Fx of _______
  • Type VIII = Fx of _________
  • Type IX = _______ of periosteum
A
  • epiphysis
  • metaphysis
  • avulsion
24
Q

What are some concerns for pediatric physeal fracture healing?

A
  • Limb length

- Angulation (altered joint reaction, biomechanical stresses)

25
Q

What is the difference between a closed and open reduction?

A
  • Closed = Done without surgical incision.

- Open = Surgical access.

26
Q

What are some indications for open reduction? (8)

A
  • Risk with bed confinement secondary to trial of conservative interventions prohibitive.
  • Decrease likelihood of success specific to Fx type.
  • Fx/displacement of articular surfaces.
  • Associated arterial injury.
  • Multiple injuries.
  • Cost.
  • Failed closed reduction.
  • Pathological Fx secondary to metastasis.
27
Q

What are the types of fixation?

A
  • Internal

- External

28
Q

What are the goals of fixation? (3)

A
  1. ) Avoid subsequent soft tissue injury.
  2. ) Maintain bone length.
  3. ) Maintain alignment.
29
Q

What are the (3) phases of Fx healing?

A
  • Inflammatory
  • Reparative
  • Remodeling
30
Q
  • ________ Bone = callus formation
  • ________ Bone = more direct osteoblastic activity
  • Surgically Compressed Bone = more direct osteoblastic activity
A
  • Cortical = callus formation

- Cancellous = more direct osteoblastic activity

31
Q

What is a common immobilization/protection timeline for both adults and children?

A
  • Adults = 6-8 weeks

- Children = 4-6 weeks

32
Q
  • Early excessive loading creates a risk for what?

- Is insufficient loading detrimental?

A
  • Pseudoarthrosis (false joint)

- Yes

33
Q

What are some factors that can affect healing and prognosis of fractures? (10)

A
  • Age
  • Degree of local trauma
  • Extent of bone loss
  • Immobilization
  • Type of bone (cortical v. trabecular)
  • Size of bone (diameter)
  • Concomitant Health Conditions
  • Hormones
  • Approximation
  • Blood supply
34
Q

What are some reasons that fractures are missed? (5)

A
  • Radiography not ordered
  • Fractures not recognized on images
  • More subtle Frxs may not be evident in initial studies
  • Multiple injuries
  • Pt Hx inadequate
35
Q

What are some common sites of elusive fractures in the spine?

A
  • C1/C2, C6/C7

- Osteoporotic compression Fx of T/L spine

36
Q

What are some common sites of elusive fractures in the UE?

A
  • Scaphoid (20%)
  • Radial head
  • Triquetrum
  • Fracture-dislocation injuries of the forearm & wrist
37
Q

What are some common sites of elusive fractures in the LE?

A
  • Femoral neck
  • Tibial plateau
  • Lateral tibial plateau avulsion Frx (Segond Fx)
  • Subtle Patella Frxs
  • Calcaneus (10%)

S8- Diagnostic Imaging (21 decks)

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